History - 19th century onwards

Dating from the 1970s, medical professionals, sociologists, anthropologists and other commentators noted the increasing visibility of a wide variety of health practices that had neither derived directly from nor been verified by biomedical science.^[57] Since that time, those who have analyzed this trend have deliberated over the most apt language with which to describe this emergent health field.^[57] A variety of terms have been used, including heterodox, irregular, fringe and alternative medicine while others, particularly medical commentators, have been satisfied to label them as instances of quackery.^[57] The most persistent term has been alternative medicine but its use is problematic as it assumes a value-laden dichotomy between a medical fringe, implicitly of borderline acceptability at best, and a privileged medical orthodoxy, associated with validated medico-scientific norms.^[58] The use of the category of alternative medicine has also been criticized as it cannot be studied as an independent entity but must be understood in terms of a regionally and temporally specific medical orthodoxy.^[59] Its use can also be misleading as it may erroneously imply that a real medical alternative exists.^[60] As with near-synonymous expressions, such as unorthodox, complementary, marginal, or quackery, these linguistic devices have served, in the context of processes of professionalisation and market competition, to establish the authority of official medicine and police the boundary between it and its unconventional rivals.^[58]

From a historical perspective, the emergence of alternative medicine, if not the term itself, is typically dated to the 19th century.^[61] This is despite the fact that there are variants of Western non-conventional medicine that arose in the late-eighteenth century or earlier and some non-Western medical traditions, currently considered alternative in the West and elsewhere, which boast extended historical pedigrees.^[58] Alternative medical systems, however, can only be said to exist when there is an identifiable, regularized and authoritative standard medical practice, such as arose in the West during the nineteenth-century, to which they can function as an alternative.^[62]

During the late eighteenth and nineteenth centuries regular and irregular medical practitioners became more clearly differentiated throughout much of Europe and,^[63] as the nineteenth century progressed, most Western states converged in the creation of legally delimited and semi-protected medical markets.^[64] It is at this point that an "official" medicine, created in cooperation with the state and employing a scientific rhetoric of legitimacy, emerges as a recognizable entity and that the concept of alternative medicine as a historical category becomes tenable.^[65] As part of this process, professional adherents of mainstream medicine in countries such as Germany, France, and Britain increasingly invoked the scientific basis of their discipline as a means of engendering internal professional unity and of external differentiation in the face of sustained market competition from homeopaths, naturopaths, mesmerists and other nonconventional medical practitioners, finally achieving a degree of imperfect dominance through alliance with the state and the passage of regulatory legislation.^[58][60] In the US the Johns Hopkins University School of Medicine, based in Baltimore, Maryland, opened in 1893 and was the first medical school devoted to teaching "German scientific medicine".^[66] Buttressed by the increased authority consequent to the significant advances in the medical sciences of the late 19th century onwards — including the development and application of the germ theory of disease by the chemist Louis Pasteur and the surgeon Joseph Lister, 1st Baron Lister, of microbiology co-founded by Robert Koch in 1885 appointed professor of hygiene at the University of Berlin, and of the use of X-rays Röntgen rays — the 1910 Flexner Report called upon American medical schools to follow the model set by the Johns Hopkins School of Medicine and adhere to mainstream science in their teaching and research. This was in a belief, mentioned in the Report's introduction, that the preliminary and professional training then prevailing in medical schools should be reformed in view of the new means for diagnosing and combating disease being made available to physicians and surgeons by the sciences on which medicine depended.^{[n 7][68]} An early instance of the influence of the Flexner Report outside North America is Peking Union Medical College.^{[69][n 8][n 9]}

Among putative medical practices available at the time which later became known as "alternative medicine" were homeopathy founded in Germany in the early 19c. and chiropractic founded in North America in the late 19c.. These conflicted in principle with the developments in medical science upon which the Flexner reforms were based, and they have not become compatible with further advances of medical science such as listed in Timeline of medicine and medical technology, 1900-1999 and 2000–present, nor have Ayurveda, acupuncture or other kinds of alternative medicine.

At the same time "Tropical medicine" was being developed as a specialist branch of western medicine in research establishments such as Liverpool School of Tropical Medicine founded 1898, London School of Hygiene & Tropical Medicine, founded 1899 and Tulane University School of Public Health and Tropical Medicine, founded 1912. A distinction was being made between western scientific medicine and indigenous systems. An example is given by an official report about indigenous systems of medicine in India, including Ayurveda, submitted by Mohammad Usman of Madras and others in 1923. This stated that the first question the Committee considered was "to decide whether the indigenous systems of medicine were scientific or not".^[70][71][72]

By the later twentieth century the term 'alternative medicine' had come into use for the purposes of public discussion,^{[n 10][74]} but it was not always being used with the same meaning by all parties. Arnold S. Relman remarked in 1998 that in the best kind of medical practice, all proposed treatments must be tested objectively, and that in the end there will only be treatments that pass and those that do not, those that are proven worthwhile and those that are not. He asked 'Can there be any reasonable "alternative"?'^[75] But also in 1998 the then Surgeon General of the United States, David Satcher,^[76] issued public information about eight common alternative treatments including acupuncture, holistic and massage, together with information about common diseases and conditions, on nutrition, diet, and lifestyle changes, and about helping consumers to decipher fraud and quackery, and to find healthcare centers and doctors who practiced alternative medicine.^[77]

By 1990, approximately 60 million Americans had used one or more complementary or alternative therapies to address health issues, according to a nationwide survey in the US published in 1993 by David Eisenberg.^[78] A study published in the November 11, 1998 issue of the Journal of the American Medical Association reported that 42% of Americans had used complementary and alternative therapies, up from 34% in 1990.^[79] However, despite the growth in patient demand for complementary medicine, most of the early alternative/complementary medical centers failed.^[80]